CLASSIFICATION – Diagnostic classification of temporomandibular disorders (TMDs) can be challenging, given the complexities inherent in presentations of headache and orofacial pain. Classification is critical to selecting the appropriate intervention. A summary of a study done by Okeson 2 estimated that about 35% or more of a population sample, which represented people of all ages, experienced physical signs and symptoms of TMD in their life. However; it was also noted that only about 5% to 10% of those that reported symptoms sought out treatment. By being able to characterize the epidemiology of and pathology of the impairment, and having an evidence based system to screen and evaluate for TMD, our doctors of physical therapy have been able to successfully treat, or refer when needed, to help those with this problem achieve a pain free life. 1
The physical therapy examination and evaluation is based on the Diagnostic Criteria for TMD, developed and validated by a consortium of specialists from the American Academy of Orofacial Pain. TMD disorders can be classified into one of three main groups:
Group I Masticatory Muscle Disorders
Group II Disc Displacements
Group III Joint Dysfunctions.
Overuse of masticatory muscles occurs with parafunctions, such as gritting, clenching, bruxing, grinding, nail biting, and gum chewing. Overuse also occurs with muscle guarding in response to conditions such as TMJ inflammation, sinusitis, or dental pathology. In addition to pain, muscle disorders can result in reduced or altered range of motion and/or alterations in the occlusal relationship of the maxillary and mandibular teeth during rest or mouth closure.
Muscles with sustained nociceptive input or with prolonged muscle guarding may develop trigger points that, when palpated, result in regional, dull, achy pain distal from the muscle itself. Trigger points are thought to form when a local energy crisis occurs at the cellular level of muscle from over activation of acetylcholine input at the neuromuscular junction, resulting in local sustained engagement of actin and myosin cross-bridges, which inhibits blood flow and activates nociceptors. Joint impairments may involve the temporomandibular disc, joint surfaces, joint capsule, ligaments, or synovium, or a combination of these structures. People whose chief complaints are joint sounds, but who do not have pain or dysfunction, should be treated conservatively with education about the remodeling process, the maintenance of healthy joint function, and the role of stress in over activation of the masticatory muscles. Preauricular pain may result from retrodiscal tissue inflammation or excessive joint loading. As inflammation resolves and tissue remodeling advances, range of motion may improve and pain may lessen, even though the altered biomechanics of DDWOR remain.
EXAMINATION – Examination and evaluation of the TMJ and related structures will further delineate TMDs and classify the problem as either masticatory muscle or joint disorder, or both, which will then determine the appropriate plan of care. Furthermore, a thorough assessment of the cervical spine is needed as cervical dysfunction can also lead or contribute to those that are experiencing orofacial pain. Skilled Mechanical Physical Therapy as utilized at Wright PT has been shown to significantly help those with TMD, who are experiencing masticatory muscle and TMJ pain, TMJ functional limitations, and cervical spine dysfunction.
SUMMARY OF EFFECTIVE WPT TREATMENTS FOR TM DISORDERS
- Trigger point release and prevention
- Instrument assisted soft tissue mobilization (IASTM)
- TMJ mobilizations for restoration of proper arthokinematics
- Cervical spine postural reeducation
- Reduction of mandibular deviations
- Stress and anxiety management
- Muscle lengthening techniques
- Correction of para-functional causes
- Modalities for Pain relief
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